A new case study was published by the American Lung Association highlighting the efforts undertaken by the North Dakota project team, through participation in the CDC 6|18 Initiative, to recognize certified tobacco treatment specialists as qualified providers under North Dakota’s Medicaid Program.
Before participating in the 6|18 Initiative, billing and reimbursement for tobacco cessation counseling through North Dakota’s Medicaid Program was possible but there were many barriers. Potential systems barriers related to billing and receiving reimbursement for tobacco cessation counseling that could be improved to increase access to treatment were identified:
- The type of professional providing the treatment had to be a qualified physician or another Medicaid-recognized healthcare provider.
- The billing codes used and whether they aligned with the patient’s symptoms;
- Documentation in the medical record had to support the billing of the cessation code; and
- The setting in which the services were provided.
The North Dakota Project team learned important lessons that states should consider before embarking on a similar effort:
- Obtain leadership buy-in upfront
- Establish strong partnerships
- Start small, then expand when it works
- Make the value add clear for partners and stakeholders
- Use data from electronic health records to inform and guide efforts
- Have dedicated staff willing to take on the work and see the effort through
- Be flexible
Want more information? Access the case study by following the link below! Also, sign up for the July 14th Webcast here!